Diarrhea

What Is Diarrhea?

Diarrhea refers to bowel movements in which loose, watery stools are passed, usually more frequently than normal during the day. Diarrhea is short-lived. It usually lasts a few days and goes away without any treatment. Diarrhea can be acute, that is, temporary, or chronic, that is, long-lasting or persistent.

Acute diarrhea occurs when the condition lasts one to two days. It may result from a viral or bacterial infection or from food poisoning. During visits and holidays in developing or third-world countries, the bacteria and parasites encountered there can cause another type of acute diarrhea known as traveler's diarrhea.

Chronic diarrhea refers to diarrhea that continues for at least 4 weeks. There is usually an underlying medical cause, such as an intestinal disease or disorder. Examples include more serious conditions such as celiac disease, Crohn's disease, irritable bowel syndrome, persistent infection or inflammatory bowel disease.

What Causes Diarrhea?

A number of different diseases and medical conditions can cause diarrhea. Chief among them is diarrhea caused by viruses. Viruses that can cause diarrhea include Norwalk virus, cytomegalovirus and viral hepatitis. In addition, rotavirus is a common cause of acute diarrhea in childhood.

Bacteria and parasites are among the most common causes of diarrhea. Spoiled or contaminated food or water carrying bacteria or parasites can allow them to enter the human body directly. Clostridium difficile is another type of bacterium that causes diarrhea and can also lead to even more serious infections. It may appear after a course of antibiotics or during a hospital stay.

Many types of medication, including antibiotics, can cause diarrhea as a side effect. Antibiotics can disrupt the natural balance of the digestive system by destroying all bacteria in the human intestine, without distinguishing between the good bacteria that aid nutrition and the bad ones. Other medications that cause diarrhea include cancer drugs and magnesium-containing antacids.

Lactose intolerance causes diarrhea. Lactose is a type of sugar found in milk and other dairy products. Some individuals may have difficulty digesting lactose and may develop diarrhea after consuming dairy products. Lactose intolerance may increase with age because, after childhood, the levels of the enzyme that helps digest lactose naturally begin to decline.

Diarrhea can also occur in individuals who have difficulty digesting fructose. Fructose is a type of sugar found naturally in fruit and honey. It is added as a sweetener to certain beverages. 

Artificial sweeteners such as sorbitol and mannitol, found in chewing gum and other similar sugar-free products, can in some cases cause diarrhea even in healthy individuals.

Diarrhea may be seen in some cases after abdominal surgery or surgery to remove the gallbladder.

Chronic diarrhea may also occur in individuals because of a number of other digestive disorders, such as Crohn's disease, ulcerative colitis, celiac disease, microscopic colitis and irritable bowel syndrome.

How Can Diarrhea Be Prevented?

To prevent viral diarrhea caused by viruses, hands must always be washed with soap. Hands should be washed frequently in order to stay properly and sufficiently clean. Hands should be washed before and after preparing food. They should also be washed after touching raw meat, using the toilet, changing diapers, sneezing, coughing and blowing the nose.

Hands should be washed with soap for at least 20 seconds. Throughout these 20 seconds, hands should continue to be rubbed with soap. If hand washing is not possible, alcohol-based hand sanitizers and disinfectants containing at least 60% alcohol should be used. Hand sanitizer should be applied like hand lotion, to the front and back of both hands. 

It is possible to protect against rotavirus, the most common cause of viral diarrhea in children, with vaccines developed against it. 

To prevent traveler's diarrhea, which usually affects people traveling to countries where environmental health measures and food hygiene are inadequate, individuals should be careful about what they eat. Well-cooked, hot food should be preferred. Raw fruits and vegetables that the person has not peeled themselves should be avoided. Raw or undercooked meat and dairy products should be avoided. Bottled water, soda, fruit juice and fermented drinks served in their original containers should be preferred.

Tap water and ice in drinks should be avoided. Bottled water should be used for brushing teeth. Keep your mouth closed while showering. Drinks made with boiling water, such as coffee or tea, will probably be safe.  However, caffeine and alcohol carry the risk of aggravating diarrhea and also of causing further dehydration.

What Are the Symptoms of Diarrhea?

Although diarrhea usually resolves on its own, adults who show signs and symptoms such as diarrhea lasting longer than a few days, dehydration (that is, excessive loss of body fluid), severe abdominal or rectal pain, bloody or black stools, or a fever above 39 degrees should see a doctor. The most important symptoms of diarrhea include:

1. Loose, watery stools
2. Abdominal cramps
3. Abdominal pain
4. Fever
5. Blood in the stool
6. Mucus in the stool
7. Bloating in the abdominal area
8. Nausea and a sudden, urgent need to use the toilet are also among the symptoms of diarrhea.

In children, especially young children and infants, diarrhea can cause very rapid dehydration. Therefore, if diarrhea in children does not improve within 24 hours, or if there are signs of dehydration, a fever above 39° C, bloody stools or black stools, a doctor must be consulted.

Dehydration is one of the most important symptoms of diarrhea. Dehydration may appear as an excessive feeling of thirst, dry skin or mouth, dark-colored urine, passing little urine or none at all, weakness, dizziness or fatigue. 

Signs of dehydration in infants and young children may appear as a diaper that stays dry for more than three hours, crying without tears, a dry mouth or tongue, lethargy, unresponsiveness to surroundings or irritability, sunken abdomen, eyes and cheeks, or a sunken fontanelle.

Dehydration can lead to particularly dangerous consequences not only in children but also in older adults and in individuals with a weakened immune system due to diabetes, kidney failure or autoimmune conditions, that is, problems of the immune system.

How Is Diarrhea Diagnosed?

Individuals who consult a doctor for the diagnosis of diarrhea are asked about their medical history and their medications are reviewed. The doctor performs a physical examination, aiming to determine what is causing the diarrhea.

A number of tests may be requested for this purpose. These tests may include a complete blood count, a stool test to check for the presence of bacteria or parasites (Diarrhea PCR panel, antigen tests or direct stool microscopy), or sigmoidoscopy or colonoscopy.

How Is Diarrhea Treated?

Diarrhea cases resolve on their own within a few days without treatment. During this process, it is important for the body to take in enough fluid. In cases that last longer, doctors may recommend various medications. Antibiotics are given by a physician's decision once the cause has been identified by testing; in Shiga toxin-producing E. coli (STEC) infection they can increase the risk of hemolytic uremic syndrome. However, if a virus is causing the diarrhea, antibiotics will not help.

Medical experts recommend replacing the water and minerals the body loses during diarrhea. This means increasing the intake primarily of oral rehydration solution (ORS), which is the first choice, as well as clean drinking water or broth. If drinking fluids upsets the person's stomach or causes vomiting, fluids can be given intravenously through a drip.

Although increasing the amount of water consumed is important for replenishing the fluids the body has lost, under normal circumstances clean drinking water does not contain enough of the salts and electrolytes the body needs to function. Oral rehydration solution (ORS) is the first choice for replacing lost fluid; fruit juices, carbonated drinks and sports drinks are not recommended. However, some fruit juices, such as apple juice, can make diarrhea even worse. Caffeine and alcohol should likewise be avoided.

If an antibiotic is causing the diarrhea, after consulting a doctor the dose of this medication may be reduced or a different medication may be substituted. Therefore, do not forget to tell the physician you consult about your diarrhea which medications you are using.

Treatment of other underlying medical conditions that cause diarrhea may be necessary. 

After the symptoms of diarrhea have gone away, semi-solid, low-fiber foods should be added back to the diet slowly. Certain foods, such as dairy products, fatty foods, high-fiber foods or heavily seasoned foods, should be avoided for a few days, and foods such as crackers, toast, eggs, rice and chicken should be preferred instead. 

In watery diarrhea without fever or blood, adults can use loperamide for a short time; it must not be used if there is fever or bloody stool, or under 18 years of age.

However, in certain medical conditions and infections, especially those of bacterial and parasitic origin, using these medications can make the condition even worse. These medications are not always suitable or safe for young children. A doctor should always be consulted before starting an antidiarrheal medication in children.

Consuming probiotics can help establish a healthy balance in the intestinal system by increasing the level of beneficial bacteria in the digestive system, but it does not shorten the duration of diarrhea.

Nutrition in Diarrhea

It is recommended to replace the water and minerals the body loses during diarrhea. This means increasing the intake primarily of oral rehydration solution (ORS), which is the first choice, as well as clean drinking water or broth. If drinking fluids upsets the person's stomach or causes vomiting, fluids can be given intravenously through a drip.

There are some dietary practices that are recommended in cases of diarrhea and from which benefit can be gained:

1. Continuing breastfeeding, if applicable
2. Yogurt, ayran (watch the salt in young age groups)
3. Boiled lean meat or chicken without spices
4. Mashed potatoes
5. Yogurt soup, pudding with little sugar
6. Fruits and vegetables high in pectin (apple, peach, banana, cranberry, carrot puree)
7. Foods low in fat, sugar and pulp

There are some dietary practices that, when restricted in cases of diarrhea, can be beneficial:

1. Avoiding caffeinated and alcoholic beverages
2. Eating foods with lower fiber content
3. Drinking fluids regularly to prevent dehydration
4. A balanced and regular diet rather than an excessive one